Document dQJbjxgN22zkbdGJ0J9jw4gj0
Inspection ID
Facility Contact Information
Class I and II Well Inspection Form
US Environmental Protection Agency - Region 4 Underground Injection Control Program
61 Forsyth Street SW, MC 9T25, Atlanta, Georgia, 30303 Phone: (404)562-9424
Inspector(s):
Carl E. Weller
_ (lead), ,
EPA Well ID#: F L S Year-Month-Day: 2 0 2
EPA Permit # (or RA):
Carol Chen
1 1 30 3 -03
N O N E
Page 1
Start Time:
End Time:
0 06
- 28
Of 2
1:24 pm 1:33 pm
Facility Name: Street Address: City:
Black Creek Energy, LLC
4940 Blackjack Plant Rd.
Jay
County:
Santa Rosa
Nature of Business:
Oil and gas production
Facility Owner/Operator:
Black Creek Energy, LLC
Email:
Mike Wetzel <mikew2859@gmail.com>
Facility Contact (if different):
Michael Wetzel
O/O Mailing Address: 140 Virginia Street, Suite 302
City:
Richmond
County:
N/A
State: FL
Zip:32565-9260
Phone: 601-431-5386 Phone: 850-324-6271
State: VA Zip: 23219
Well Name & #: Well Type (see table): Latitude (N):
Curtis B. Lowery #10-E
Enhanced Oil Recovery (EOR)
30.87013042
Longitude (W):
API No. 09113320125 PA No. 303047
State Permit:
-87.12829494
OG_ 686
Elevation (ft):
Injection Method (check applicable): Casing Injector; X Tubing & Packer; Cemented Injection Tubing
PBTD: 15930'
Other: srfc csg 9" @3929'
Baker FB-1
Total Depth (ft): 16025' Inner Casing Size (in):
Tubing Size (in):
Packer Depth (ft): 15650'
Inj. Zone: Open Hole; X Perforated; Top(ft) 15870'
Bottom(ft):
15906'
(4/84)
2500 psi
Max. Injection Pressure (psig):
Latitude (N):
30.870186
Longitude (W):
-87.128298
Elevation (ft):
EPA GPS ID: SX8123 Well Status (see table): AC If not Active, Reported Date Last Active:
Nature of Injected Fluid(s) if any: Produced fluids
General Condition of the Well Site:
Well Data from File
Field Measurements and Observations
Notes & Comments (include discrepancies from database values):
Tubing gauge: Production gauge: Surface gauge: Flowline gauge: Injection well passed a mechanical integrity test on 9/20/2021
1600 psi 0 psi 0 psi
1499 psi
Name: Signature:
See reverse for additional observations, comments and photo log
U IC Inspector
UIC Inspector
Carl E. Weller
Digitally signed by CARL WELLER
CARL WELLER (Affiliate) (Affiliate)
Date: 2023.05.11 13:16:38 -04'00'
Name: Carol Chen
Signature: CAROL CHEN Date: 2023.05.10 18:59:02 -04'00' Digitally signed by CAROL CHEN
Version 2018-04-18
Class I and II Well Inspection Form
US Environmental Protection Agency - Region 4 Underground Injection Control Program
61 Forsyth Street SW, MC 9T25, Atlanta, Georgia, 30303 Phone: (404)562-9424
(Cont)
Inspection ID
EPA Well ID#: F L S 1 1 3 0 0 0 6 Year-Month-Day: 2 0 2 3 - 0 3 - 2 8
EPA Permit # (or RA): N O N E
Page 2 Of 2
Field Measurements and Observations (Cont.)
Photo Log
Photographer: Photo ID: Description: Photo ID: Description:
Carl E. Weller
158
Time: 1:23 pm
EPA Camera ID:
Lat (N): 30.87040
sign posted
159
Time: 1:236 pm Lat (N): 30.87019
photo of injection well
SX8123
Long (W)
-87.12865
Long (W)
-87.12830
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
Photo ID:
Time:
Lat (N):
Long (W)
Description:
UIC Inspector
Name: Signature:
Carl E. Weller
CARL WELLER (Affiliate)
Digitally signed by CARL WELLER (Affiliate) Date: 2023.05.11 13:17:10 -04'00'
UIC Inspector
Name: Carol Chen
Signature: CAROL CHEN Date: 2023.05.10 18:59:40 -04'00' Digitally signed by CAROL CHEN
Version 2018-04-18